Hepatitis c
- 1. Hepatitis C Anatomy and physiology of liver Function of liver Glucose metabolism. Fat metabolism. Protein metabolism. Vitamin and iron storage. Ammonia conversion. Detoxification of drugs and toxic substances. Synthesis of plasma proteins Bile formation. Bilirubin excretion.
- 2. Defination Hepatitis C is a systemic viral infection in which inflammation and necrosis of the liver cells occurs. It is one of the leading cause of liver inflammation now a days caused by hepatitis C virus (HCV) Incubation period The infection is often asymptomatic. Incubation period may varies from 15 to 160 days. Senerio of hepatitis C Approximately 35,000 new cases of hepatitis C are reported in the United States each year. There are 10,000 to 12,000 deaths each year in US due to hepatitis C. WHO estimates that there are 130 to 170 million people infected globally. Hepatitis C virus Hepatitis virus is a small, enveloped RNA virus There are 7 genotypes of HCV and the genotypes are divided into many subtypes. There is no vaccine or immunoglobulin made till now for hepatitis C. Pathophysiology Exposure to hepatitis C virus Liver cells are damaged in two ways: by direct action of the virus or by immune response to the virus Cell injury results in inflammation and necrosis in the liver. With severe inflammation of the liver, cannot conjugate bile which leads to jaundice Necrosis in the liver leads to portal hypertention and esophageal varices Fibrosis ,chirrhosis and carcinoma of the liver Risk factors for hepatitis C It mainly spreads through parental route. Intravenous drug users (IUDs) Past/current iv injection drug use Blood transfusion infected with HCV Organ transplant from a donor who is infected with HCV Multiple sex partners, history of sexually transmitted disease, unprotected sex. Sharing personal care items such as razors, scissors, nail clippers or a toothbrush with an infected person. Health workers after needle stick injuries or mucosal exposure to boold Children born to women infected with hepatitis C virus Using non-sterile instruments and needles for tattooing and body piercing. Clinical manifestations 1. Acute infection: hepatitis c infection causes acute symptoms in 15% of cases. Symptoms are generally mild which includes: Fatigue Nausea Anorexia Weight loss Muscle or joint pain Jaundice The infection may resolve in 10 to 50% of cases.
- 3. 2. Chronic infection:about 80% of those exposed to the virus develop a chronic infection. Sign and symptoms includes: Fatigue Jaundice Fatty changes to the liver Portal hypertention Liver cirrhosis Esophageal varices Hepatocellular carcinoma Diagnosing hepatitis C History taking. Physical examination. Anti HCV test: detects the presence of antibodies to the HCV in the blood. Laboratory diagnosis LAB TESTS Pigment tests: Serum bilirubin (total) Serum bilirubin (direct) CLINICAL FUNCTIONS These studies measures the ability of the liver to conjugate and excrete bilirubin. Protein studies: Total serum protein Serum albumin Serum globulin Proteins are manufactured by the liver. Their levels may be affected in viral hepatitis, chronic hepatitis and other liver impairments. Prothrombin time Prothrombin time will be prolonged in liver damage. Transaminase studies: AST (SGOT) ALT (SGPT) These enzymes are elevated in liver cell damage. Serum ammonia Liver converts ammonia to urea. Ammonia level rises in liver damage. Ultrasonography To determine size of liver Liver biopsy To determine anatomic changes in liver tissue. CT scan To detect hepatic neoplasm; diagnose cysts, abscesses, hematomas and obstruction. MRI To detect hepatic neoplasm; diagnose cysts, abscesses, hematomas and obstruction. Endoscopy To search for esophageal varices and other abnormalities.
- 4. Treatment Combination of two antivirus agents, interferon (intron-A) and ribavirin (rebetal) is effecting in producing improvement in patient with HCV. Liver transplant if liver is damaged completely. Complications Life threatening esophageal and gastric varices Cirrhosis of the liver Liver failure Carcinoma of the liver Nursing management o Assessment: assess: Activity o Weakness o Fatigue o Malaise Elimination o Dark urine o Diarrhoea Food and fluids o Anorexia o Weight loss o Nausea and vomiting o Increased edema o Ascitis Neuro-sensory o Lethargy Pain o Abdominal cramps o Liver tenderness o Splenomegaly o Itching (pruritis) NURSING DIAGNOSIS: Fatigue related to decreased metabolic energy production secondary to liver dysfunction. Imbalanced nutrition: less than body requirement related to anorexia, nausea, bile stasis and altered absorption and metabolism. Anxiety related to uncertainty of the effects of hepatitis. Impaired skin integrity related to pruritus. Nursing management Encourage for ADLs. Teach to avoid alcohol. Provide vitamin supplements as ordered. Relieve nausea and vomiting. Explain about the disease and its management to relieve anxiety and worries. Provide psycological support to the patient and family members Teach the patient to take adequate rest Maintain high calorie and low fat diet Manage pain by using ordered analgesics
- 5. Maintain cleanliness without causing dry skin Advise not to scratch the skin to prevent from further infection Prevention At present, no vaccine exist to prevent infection with HCV, therefore its important to avoid exposure to the virus. Screening of the blood should be done before transfusions Blood transfusion should be given only when absolutely necessary Public health awareness programs should be conducted on shared needles in iv or injection drug use. Avoid multiple sexual partners and use condoms for prevention. Use universal precautions for every patient while working in hospitals and other health care facility. Do not share toothbrush, razor or anythingelse that might have blood on it or contaminated with the person having HCV If you want to get tattoo or have your body pierced, make sure the practioner sterilize the instrument and supplies Call your doctor if you have symptoms of hepatitis or if you think you may have been exposed to someone who has it.